協助一位初次腦中風患者戒菸之照護經驗

本文描述一位50歲重菸癮男性初次腦中風進行戒菸之照護經驗。照護期間為2021年4月25日至2021年5月1日，並持續於個案出院後門診訪視兩次及三次電話訪談追蹤至2021年6月29日結案。筆者運用四大層面評估，以身體評估、會談及病歷查閱等方式收集資料，確立個案健康問題為：身體活動功能障礙／左側肌力下降、知識增進的準備度／與缺乏糖尿病自我管理有關、無效性健康維護能力／與抽菸有關。照護期間鼓勵個案積極復健增進患側肢體活動度，提供糖尿病飲食與血糖控制等知識，以增進血糖控制。抽菸行為以跨理論模式作為評估個案戒菸行為改變階段與介入措施之依據，沉思期以腦中風會導致身體功能障礙增強戒菸之意念，準備期與個案共同規劃戒菸計畫與設立可達成之目標，行動期鼓勵個案表達戒菸之不適感，移除誘發抽菸之物品，提供社會資源。戒菸行為在出院後通常較住院期間艱難，因此持續於個案門診時約訪及電話追蹤了解戒菸困境。個案在電訪追蹤七周的期間內確實成功降低抽菸數量與頻率，醫療人員持續追訪與關照是個案戒菸行動的助力，期望此護照經驗可提供醫療人員照護此類個案之參閱。

關鍵字

跨理論模式；戒菸；腦中風

並列摘要

This paper describes the smoking cessation nursing experience of a 50-year-old male with heavy smoking addiction during his first stroke. The care period was from April 25 to May 1, 2021, followed by two outpatient visits and three telephone interviews after discharge until June 29, 2021. Comprehensive physical assessment, interviews, and medical records were employed for data collection. The patient's health problems identified were impaired physical mobility, ineffective health maintenance, and readiness for enhanced knowledge. The nursing period encouraged positive rehabilitation to improve the muscle power of left limbs and provide knowledge of diabetic diet for blood sugar control. A transtheoretical model was adopted as the basis for assessing the stages of change and intervention measures for the patient's smoking cessation behaviors, and corresponding strategies were implemented at different stages. During the contemplation stage, the case was informed of the possible physical dysfunction caused by stroke, which strengthened his intention to quit smoking. During the preparation stage, the case jointly planned a smoking cessation plan and set achievable goals. During the action stage, the case was encouraged to express his discomfort about quitting smoking, remove smoking-inducing substances and provide social resources. Interviews with the case were conducted at the smoking cessation clinic. Continuous telephone follow-ups were implemented to understand the difficulties and results of quitting smoking. Smoking cessation is usually not achieved overnight, and it is usually more difficult for cases to quit smoking after discharge than during hospitalization. Thus, continuous follow-ups and care by medical personnel provide a boost to the individual during their smoking cessation action. The case in this paper did successfully reduce the number and frequency of smoking during the seven-week telephone follow-up. It is expected that this nursing experience can be used as a reference for medical personnel to assist such cases in smoking cessation.

並列關鍵字

Transtheoretical Model ； smoking cessation ； stroke

參考文獻

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